MEDICARE: DALUZ OPTICAL AND SUPPLIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WX0102X	Occupational Vision Optometrist	471891-3	FL
2	156FX1800X	Optician	OE 1493	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679627772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALUZ OPTICAL AND SUPPLIES INC

Provider Business Mailing Address
First Line	:	4528 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-557-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	305-557-6777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. REINALDO HUERTAS
Credential	:
Telephone Number	:	305-557-6777

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/24/2008

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